Authors: P. Dzvinčuk 1; R. Pilka 1; Milan Kudela 1; P. Koranda 2 Authors‘ workplace: Gynekologicko-porodnická klinika FN a LF UP, Olomouc, přednosta prof. MUDr. M. Kudela, CSc. 1; Klinika nukleární medicíny FN a LF UP, Olomouc, přednosta doc. MUDr. M. Mysliveček 2 Published in: Ceska Gynekol 2006; 71(3): 231-236 Category: Original Article
Objective: The aim of this study was to evaluate the feasibility of pre-operative lymphoscintigraphy and radio-guided surgery in endometrial cancer patients after intramyometrial administration of labelled colloid.
Desing: Prospective study.
Setting: Department of Obstetrics and Gynaecology of the Palacký University Medical School and University Hospital, Olomouc, Czech Republic.
Patients and methods: Between April 2002 and March 2005, thirty three patients with endometrial cancer received pre-operatively 50 MBq of 99mTc-nanocolloid. The radiopharmaceutical agent was administered by a 25 Gauge needle transcervically into the myometrium. Subsequently, series of static lymphoscintigrams were made 20 to 90 min after injection. Two hours after injection the surgery started. Twenty eight patients underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Five patients were scheduled for laparoscopically assisted vaginal hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Paraaortal lymphadenectomy was performed in 11 cases. A gamma detecting probe was used to locate radioactive lymph nodes during operation. Each hot lymph node was removed separately.
Results: Sentinel lymph nodes (SLN) were identified in 26 (79%) of 33 patients. The mean number of sentinel nodes detected was 2.9 (range 1-10). Seventy two (15.3%) of 472 nodes obtained in total, were identified as radioactive-colloid positive. Histopathological analysis revealed five (7%) of 72 lymphonodes to be positive of metastases. Sentinel nodes in paraaortic area were identified in 11 (33%) patients. No false negative sentinel lymphonodes were observed.
Conclusion: The preoperative lymphoscintigraphy and intraoperative gamma probe guided biopsy may be useful in identifying sentinel nodes in endometrial cancer. No false negative sentinel lymphonodes were observed if representative SLNs were diagnosed with tumor.
Key words: endometrial cancer, sentinel nodes, intraoperative lymphatic mapping, lymphoscintigraphy
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